改良一体式阻鼾器对阻塞性睡眠呼吸暂停综合征患者颞下颌关节的影响

Temporomandibular joint changes in patients with obstructive sleep apnea syndrome treated with a modified oral appliance

目的观察阻塞性睡眠呼吸暂停综合征(OSAS)患者夜间佩戴改良一体式阻鼾器治疗对颞下颌关节的影响。方法对就诊的经改良一体式阻鼾器治疗的男性患者32例,采用Helkimo主诉症状指数(Ai)将患者分为无症状组和轻度症状组。2组患者佩戴改良一体式阻鼾器前、佩戴1周及4周后,采用Ai观察患者的主观症状改变,肌电图检测下颌姿势位与最大紧咬时颞肌前束和咬肌的肌电幅值变化以评价疗效。结果佩戴改良一体式阻鼾器1周后,2组AiⅠ级和AiⅡ级分布比例明显增高;佩戴4周后无症状组Ai 0级的分布比例回升至佩戴前,轻度症状组AiⅡ级比例明显减少。肌电图结果显示,轻度症状组下颌姿势位时佩戴改良一体式阻鼾器前及佩戴后双侧咬肌和颞肌前束的肌电幅值均明显高于无症状组(P<0.001);2组患者在佩戴改良一体式阻鼾器1周后,下颌姿势位时双侧咬肌和颞肌前束肌电幅值较佩戴前明显增高,最大紧咬时无症状组肌电幅值较佩戴前降低,P<0.05;佩戴4周后2组下颌姿势位时咬肌和颞肌前束肌电幅值均下降,与佩戴前差异无统计学意义(P>0.05)。结论改良一体式阻鼾器未对咬肌和颞肌前束的肌电活动产生不良影响,患者使用改良一体式阻鼾器初期会出现轻微的颞下颌关节紊乱症状,随着肌肉、神经、关节、间的平衡重新建立,症状会逐渐消失,不会导致肌源性颞下颌关节紊乱或轻度颞下颌关节紊乱病情加重。

Objective To investigate into the effect of a modified oral appliance（MOA） on the electromyographic activity of the masseter and temporal muscles in individuals with obstructive sleep apnea（OSA）.Methods A total of 32 patients whose airway obstruction was treated with an MOA during sleep were included in the study from the Sleep Medicine Centre of Gansu Provincial People＇s Hospital from March 2014 to January 2015. The subjects were classified into a group without TMD and one with mild TMD according to the Helkimo anamnestic dysfunction index（Ai）. The Ai scores and electromyography（EMG） of biolateral anterior temporalis（TA） and masseter muscle（MM） were recorded before, one week and four weeks after the treatmentwith MOA in order to monitor the changes of subjective symptoms and the EMG activity. Results In the first week after treatment with MOA, Ai was redistributed in the two groups, with AiⅠand AiⅡ ratio having been significantly increased. 4 weeks after wearing the MOA, the Ai 0 level ratio increased compared with the group without TMD before treatment. The Ai Ⅱ level ratio decreased significantly at week 1 in patients with mild TMD. The EMG levels in the MM and TA of patients with mild TMD were higher（P 〈0.001）. Significant differences were observed in the MM and TA activity in two groups before and after treatment with MOA during mandibular postural position（MPP）. After 1 week treatment with MOA, the MM and TA muscle levels were significantly increased during MPP（P〈0.05）, but decreased in the group without TMD during maximum voluntary clenching（MVC）（P〈0.05）. The electromyographic activity of the MM and TA during MVC and MPP after 4 weeks of follow-up showed no significant difference in two groups（P〉0.05）. Conclusion The MOA does not cause masticatory dysfunction and is a safe alternative for OSA patients without or with mild TMD.Some side effects are mainly transitory and reversible.